PLATIPUS Trial: comparison of different pain relief strategies in haemorrhoid banding

Haemorrhoids are enlarged veins in the anus or lower rectum, which can cause bleeding, itching, pain and prolapse outside of the anal canal. The disease is commonly managed using rubber band ligation (RBL), where a band is placed around the base of the haemorrhoid, preventing blood flow to the haemorrhoid and causing it to fall off and pass through the anal canal. The most common complication of RBL is pain. Currently, surgeons vary widely in their approach to preventing pain in these patients, owing to a lack of quality evidence supporting one strategy over another. Surgeons may inject local anaesthetic at the site where the band is placed, or use it to block the nerve supplying the anus and lower rectum. Some patients receive no local anaesthetic, and rely on standard postoperative medications such as paracetamol, anti-inflammatories, and opioids. There is a need for quality research to determine the best strategy for pain management in patients undergoing this common procedure. In our study, participants undergoing RBL will be randomly assigned to receive either local anaesthetic at the banding site, a nerve block, or standard postoperative medications only. These pain management strategies are all routinely used in practice and are safe procedures common in many operations. At several timepoints following the procedure, participants will be asked to report their pain on a scale (up until 2 weeks post procedure). Participants’ use of pain medications in recovery; the time taken for participants to be discharged after their procedure; participant satisfaction with their procedure; the time it takes for participants to return to work after their procedure; and procedure associated complications, will also be recorded. These outcomes will then be used to determine which strategy is best for managing pain in patients undergoing RBL. We hypothesise that both pudendal nerve block and submucosal infiltration of local anaesthetic will be superior to no local anaesthetic for post-procedural pain management.